amphotericin-b and Corneal-Injuries

We report our experience in treating two cases of Scedosporium apiospermum keratitis and provide a review of basic scientific and clinical data regarding the treatment of this visually devastating disease.. We present a case report and literature review.. A 35-year-old woman and a 73-year-old man both reported pain, redness, and a foreign body sensation in the eye after trauma. They were initially treated with antibacterials. When cultures were positive for S. apiospermum, the first patient was treated with fluconazole and amphotericin with good results. The second was treated with fluconazole and natamycin, but the infection persisted and the eye was eventually enucleated. Review of the literature showed variable responsiveness of S. apiospermum to antifungal treatment.. It is difficult to predict how S. apiospermum keratitis will respond to treatment, but miconazole appears to be useful in conjunction with other antifungals. Voriconazole shows promise as an effective alternative.

Topics: Adult; Aged; Amphotericin B; Cornea; Corneal Injuries; Drug Therapy, Combination; Eye Enucleation; Eye Infections, Fungal; Eye Injuries, Penetrating; Female; Fluconazole; Humans; Keratitis; Male; Mycetoma; Natamycin; Scedosporium

Topics: Administration, Topical; Amphotericin B; Anemia, Aplastic; Anti-Infective Agents; Benzamidines; Chronic Disease; Conjunctivitis; Conjunctivitis, Allergic; Corneal Injuries; Dermatitis, Contact; Drug Eruptions; Epithelium; Humans; Idoxuridine; Keratitis; Stevens-Johnson Syndrome; Sulfonamides; Wound Healing

The purpose of this study was to determine whether astigmatism or corneal scarring is mediating the reduced visual acuity among patients with fungal keratitis randomized to corneal cross-linking (CXL).. This was a prespecified exploratory outcome from an outcome-masked, 2 × 2 factorial design, randomized controlled clinical trial.. Consecutive patients presented with moderate vision loss from a smear-positive fungal ulcer at Aravind Eye Hospital, Madurai, India.. Study eyes were randomized to one of 4 treatment combinations using an adaptive randomization protocol. The treatment arms included (1) topical natamycin 5% alone, (2) topical natamycin 5% plus CXL, (3) topical amphotericin B 0.15% alone, and (4) topical amphotericin 0.15% plus CXL. Best spectacle-corrected visual acuity (BSCVA), contact lens over-refraction, and scar size and depth as measured by a masked study ophthalmologist using a standardized protocol were recorded at 3 months. Pentacam Scheimpflug imaging was also obtained at 3 months.. BSCVA and contact lens over-refraction, infiltrate and/or scar size and depth, total astigmatism of the front and back of the cornea, total lower-order and higher-order aberrations of the anterior and posterior cornea, and total densitometry of the anterior, central, and posterior stroma were recorded. We performed a mediation analysis looking at the proportion of the effect of CXL on BSCVA that was mediated through scar size, scar depth, astigmatism and density.. BSCVA at 3 months was available for 99 of 111 patients (89%) who had a mean of 0.82-LogMAR (SD 0.68). Three-month infiltrate and/or scar size ( P < 0.001), depth ( P < 0.001), and densitometry ( P = 0.001) were statistically significant predictors of 3-month BSCVA. Astigmatism seemed to mediate 23% of the effect of CXL on BSCVA, whereas scar size mediated 23%, scar depth 17%, and densitometry 7%.. Corneal scarring and astigmatism are mediators of worse visual acuity after cross-linking in fungal keratitis. Corneal densitometry may be a helpful cornea-specific variable for clinicians and researchers in determining the effect of corneal scarring on visual acuity in specific patients and as an objective study outcome.. NCT02570321.

Topics: Amphotericin B; Astigmatism; Cicatrix; Cornea; Corneal Injuries; Corneal Ulcer; Cross-Linking Reagents; Eye Infections, Fungal; Humans; India; Natamycin; Treatment Outcome; Ulcer; Visual Acuity

Topics: Administration, Topical; Amphotericin B; Antifungal Agents; Cornea; Corneal Injuries; Corneal Stroma; Eye Infections, Fungal; Female; Fluconazole; Humans; Immunocompromised Host; Keratitis; Middle Aged; Pichia; Plant Leaves; Treatment Outcome; Visual Acuity

Fungal keratitis is rare in France, but could be a severe sight-threatening condition. Here, we aimed to describe the epidemiology of fungal keratitis in Réunion Island.. In a retrospective study, we analyzed 13 culture-proven keratitis episodes, occurred between January 2013 and July 2017 in the ophthalmology ward of a University Hospital, Saint-Pierre. Twelve isolates were genotyped and antifungal susceptibility testing was performed.. Corneal abrasion caused by vegetable matter was the main predisposing factor. Stromal infiltration was observed in 12 patients. Six patients did not response to medical treatment, requiring surgical care, including two enucleations surgery. Fusarium solani (n = 6) and Fusarium dimerum (n = 4) were the main fungal species involved in fungal keratitis. Clinical failures were more prevalent with F. solani infections. The lowest minimal inhibitory concentrations for Fusarium sp. were observed with voriconazole and amphotericin B.. In Reunion Island, the epidemiology of fungal keratitis is characterized by the predominance of Fusarium species, potentially involved in visual loss. This pattern is consistent with the epidemiology usually observed in tropical areas.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Corneal Injuries; Eye Infections, Fungal; Female; Fusariosis; Hospitals, University; Humans; Keratitis; Male; Middle Aged; Retrospective Studies; Reunion; Voriconazole; Wound Infection

Topics: Amphotericin B; Antifungal Agents; Ascomycota; Cornea; Corneal Injuries; Endophthalmitis; Eye Foreign Bodies; Eye Infections, Fungal; Eye Injuries, Penetrating; Humans; Keratoplasty, Penetrating; Male; Middle Aged; Mycoses; Sclera; Ultrasonography; Visual Acuity; Vitreous Body; Young Adult

To construct a suitable ex vivo model for the research of molecular mechanisms and the pharmacological screening of fungal adherence on the corneal surface.. Mouse eyes were divided into three groups as follows: a control group with normal corneal epithelium, a group with corneal epithelium that was needle-scarified, and a group with corneal epithelium that was completely debrided. All 96 corneas were placed in organ culture and inoculated with 5 μl spore suspensions of Candida albicans at 10⁹, 10⁸, or 10⁷ colony-forming units (CFU)/ml and incubated for 0, 30, 60, or 120 min. The corneas were homogenated and diluted for quantification by counting the CFU. The effects of amphotericin B or chondroitin sulfate on the adherence of the fungal spores were evaluated with the ex vivo organ culture model and were also compared with the human corneal epithelium monolayer model in vitro.. Compared with the normal corneas with intact epithelium, the corneas with scarified and debrided epithelium adhered more spores for above two and four folds. The spore adhesion on the corneal surface was in an inoculation concentration- and incubation time-dependent manner. Moreover, both amphotericin B and chondroitin sulfate inhibited the adhesion of C. albicans spores on the corneal surface, but the inhibitory rates were different between the ex vivo corneal organ culture model and the in vitro corneal epithelium monolayer model.. The corneal organ culture was a suitable ex vivo model for the research of fungal adhesion mechanisms and drug screening.

Topics: Amphotericin B; Animals; Bacterial Adhesion; Candida albicans; Candidiasis; Chondroitin Sulfates; Colony Count, Microbial; Cornea; Corneal Injuries; Corneal Ulcer; Disease Models, Animal; Eye Infections, Fungal; Mice; Mice, Inbred BALB C; Organ Culture Techniques; Time Factors

To report the first case of fungal keratitis caused by presumed Carpoligna species.. A 37-year-old gardener sustained a full-thickness, stellate corneal laceration while cutting wood outdoors with a circular saw. Two months after surgical repair, he developed a severe infectious keratitis with descemetocoele at the apex of the original stellate laceration.. Culture results confirmed fungal elements without evidence of bacteria. Oral and topical voriconazole were initiated. Due to compliance and cost issues, voriconazole was replaced with natamycin 5% prior to discharge from hospital. The patient improved and healed without perforation. The patient was left with a central stromal scar. DNA extraction from the fungal colony allowed PCR amplification of the 28s ribosomal RNA region of the fungus that led to the diagnosis of Carpoligna pleurothecii. Corticosteroids were never used during the patient's treatment.. This is the first reported case of infectious keratitis caused by presumed Carpoligna species. The treatment for Carpoligna pleurothecii keratitis includes voriconazole, natamycin, and possibly amphotericin B.

Topics: Adult; Amphotericin B; Antifungal Agents; Base Sequence; Corneal Injuries; Corneal Ulcer; DNA, Fungal; Eye Infections, Fungal; Eye Injuries; Humans; Lacerations; Male; Mitosporic Fungi; Molecular Sequence Data; Natamycin; Polymerase Chain Reaction; Pyrimidines; RNA, Fungal; RNA, Ribosomal, 28S; Triazoles; Voriconazole

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Cornea; Corneal Injuries; Eye Infections, Fungal; Foreign Bodies; Humans; Keratitis; Male; Metals; Middle Aged

Topics: Amphotericin B; Cornea; Corneal Injuries; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Bacterial; Eye Injuries, Penetrating; Fluconazole; Gram-Negative Bacterial Infections; Humans; Male; Middle Aged; Ofloxacin; Stenotrophomonas maltophilia; Visual Acuity

Severe eye burns occur rarely, but are related to a poor prognosis in rehabilitation. As emergency treatment has been identified as decisive factor for the prognosis of eye burns, new first aid rinsing solutions should be considered carefully in their clinical action. In a first approach, the new drug Diphoterine was subjected to a comparison with saline solution to evaluate the effects in a model of severe eye burns.. In a double-masked experiment 16 rabbits underwent a severe eye burn of one cornea followed by immediate rinsing with 0.9% sodium-chlorine solution (n=8) or Diphoterine (n=8). During 16 days after burn, an irrigation therapy with 0.9% saline solution three times daily 160 ml was applied in both groups following the recommendation of prolonged irrigation therapy performed in our clinic. In a similar setup, 16 eyes were subjected alkali burns with measurements of aqueous humor pH within 30s after burn and after a period of 5 min rinsing with 500 ml saline 0.9% or Diphoterine, respectively.. The result of the severe eye burn with an opaque cornea was similar in both groups. During rinsing no fibrin precipitates occurred in the Diphoterine rinsed group whereas this was detectable in all eyes rinsed with saline solution. After 16 days there was no difference between both groups indicating no harmful effect of Diphoterine as emergency treatment compared to saline 0.9%. After 30s of burn with 1N NaOH and rinsing with 500 ml of the specified solutions the anterior chamber pH was 10+/-0 in the saline group and 9.35+/-0.3 in the Diphoterine group showing efficacy of the buffering capacity of Diphoterine.. Diphoterine proves to be efficient in the primary treatment of burns. The anterior chamber pH could be lowered by 5min of rinsing. No harmful effects of Diphoterine could be observed compared to rinsing with saline solution in the course of an severe alkali burn of the cornea.

Topics: Alkalies; Amphotericin B; Animals; Anti-Bacterial Agents; Burns, Chemical; Cornea; Corneal Injuries; Corneal Opacity; Corneal Ulcer; Emergency Treatment; Eye Burns; Models, Animal; Ophthalmic Solutions; Rabbits; Random Allocation; Single-Blind Method; Sodium Chloride; Therapeutic Irrigation; Time Factors

To describe a patient with Exophiala jeanselmei keratitis. METHODS.. One patient with persistent corneal infiltrate that developed several days after a minor ocular trauma from an onion slice.. Culture plates from corneal scraping showed a growth of the yeast Exophiala jeanselmei, a rare causative agent of ocular infection.. Whenever a corneal abscess does not improve with the usual antibiotic treatment, a thorough ophthalmic history should be taken to determine whether there was a recent ocular trauma. If the trauma was caused by a plant material, the physician should raise the possibility of an unusual fungal infection.

Topics: Amphotericin B; Anti-Infective Agents, Local; Chlorhexidine; Corneal Injuries; Drug Therapy, Combination; Exophiala; Eye Infections, Fungal; Eye Injuries; Female; Humans; Keratitis; Middle Aged; Mycoses; Natamycin; Wounds, Nonpenetrating

Fungal keratitis is a significant cause of ocular morbidity in India. The most commonly implicated fungi are Aspergillus spp. Patients often present with hypopyon, which usually contains fungal elements. The treatment is difficult owing to poor intraocular penetration of most available antifungal agents. This study evaluated the results of intracameral injection of amphotericin B in natamycin resistant cases of severe keratomycosis.. Three patients of culture proven Aspergillus flavus corneal ulcer with hypopyon not responding to topical natamycin 5%, amphotericin B 0.15%, and oral itraconazole were administered intracameral amphotericin B. The first case received 7.5 microg in 0.1 mL followed by two subsequent injections of 10 microg in 0.1 mL each, the second case received two injections of 10 microg in 0.1 mL, and the third patient received a single dose of 10 microg in 0.1 mL. Culture of the aqueous sample also grew A. flavus in all three cases.. All three cases responded favorably, with the ulcer and hypopyon clearing completely. There was no clinical evidence of corneal or lenticular toxicity in any patient.. Intracameral amphotericin B may be a useful modality in the treatment of severe keratomycosis not responding to topical natamycin. It ensures adequate drug delivery into the anterior chamber and may be especially useful to avoid surgical intervention in the acute stage of the disease.

Topics: Adult; Amphotericin B; Anterior Chamber; Antifungal Agents; Aqueous Humor; Aspergillosis; Aspergillus flavus; Corneal Injuries; Corneal Ulcer; Eye Infections, Fungal; Eye Injuries; Humans; Injections; Male; Suppuration

To report two patients with severe fungal corneal ulcers who were treated successfully with topical amphotericin B ointment.. Two eyes of two patients developed corneal ulcers and hypopyon after corneal foreign body removal. Aspergillus fumigatus and Fusarium solani were isolated in Patients 1 and 2, respectively. By antifungal susceptibility testing, amphotericin B was shown to have the lowest minimal inhibitory concentration.. Topical administration of amphotericin B ointment resulted in dramatic improvement in fungal corneal ulcers.. Antifungal susceptibility tests may aid with selection of antifungal agents. Amphotericin B ointment is one of the promising therapies for keratomycosis caused by antimycotic-resistant fungi.

Topics: Administration, Topical; Aged; Amphotericin B; Antifungal Agents; Aspergillus fumigatus; Cornea; Corneal Injuries; Corneal Ulcer; Eye Foreign Bodies; Eye Infections, Fungal; Female; Follow-Up Studies; Fusarium; Humans; Male; Middle Aged; Mycoses; Ointments

Keratomycosis due to Aspergillus fumigatus occurs most often in immuno-competent patients who live and work in a fungus-rich atmosphere. Previous trauma with epithelial lesion are reported by most authors. While the new antifungal drugs may be effective, corneal graft is the most effective solution in uncontrolled cases. When performed early, good visual recovery was observed in most cases as reported in the literature and in our case.

Topics: Accidents, Occupational; Adult; Agrochemicals; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Caustics; Corneal Injuries; Corneal Transplantation; Corneal Ulcer; Environmental Microbiology; Humans; Male

Topics: Administration, Topical; Amphotericin B; Bacitracin; Corneal Injuries; Corneal Ulcer; Eye Injuries; Gentamicins; Humans; Male; Middle Aged; Mitosporic Fungi; Mycoses; Natamycin; Neomycin; Ophthalmic Solutions; Polymyxins; Sulfacetamide; Wound Infection